Home diabetes kits waste £100m a year, says research
Friday April 18, 2008
The NHS is wasting more than £100m
a year by helping people with diabetes to monitor their condition at home because it only serves to make them anxious, researchers
will say today.
For 10 years, doctors have argued
over whether blood-glucose monitoring at home is useful for people with type 2 diabetes, the form of the disease often linked
to obesity, which is soaring in the UK.
Those with type 2 diabetes are not
dependent on insulin injections and can take various measures to help themselves, such as sticking to a careful diet, watching
their weight and exercising. Home blood-glucose monitoring, involving a small finger-prick to obtain a drop of blood and a
test kit, was introduced to allow people to check on how well they were doing.
Self-monitoring is generally agreed
to work for people who are insulin-dependent. But two studies published today in the British Medical Journal reveal a different
picture for those who are not.
One of the studies, by Maurice O'Kane
and colleagues at Altnagelvin Area hospital , Londonderry, randomly assigned 184 diabetes patients either to self-monitoring
or to no monitoring for a year.
The researchers say they were "unable
to identify any significant effect of self-monitoring" on glucose levels, the use of medication or hypoglycaemic attacks.
Furthermore, they say, the self-monitoring group scored 6% higher on a rating scale designed to assess depression and had
"a trend towards increased anxiety".
They suggest this negative effect
"might relate less to feelings of powerlessness in the face of high blood-glucose readings than to the enforced discipline
of regular monitoring without any tangible gain".
The second study, by Judit Simon
and colleagues at Oxford University, looked at cost-effectiveness in a group of 453 patients, randomised to self-monitor or
not. They found self monitoring cost up to £92 per patient more than standard care.
In 2004, 1.5 million people in the
UK had type 2 diabetes, and the bill for self-monitoring is in excess of £100m a year, the researchers say, and yet it is
not cost-effective. The self-monitoring groups did not do better and they "showed reductions in quality of life". The study,
they say, "provides no convincing evidence for routinely recommending self-monitoring to patients with non-insulin treated
type 2 diabetes".
In an editorial, Martin Gulliford,
professor of public health at King's College London, said the £100m cost represented "a substantial opportunity" to invest
in other ways of helping people with type 2 diabetes. But the patients' organisation Diabetes UK appeared unconvinced. "Short-term
cost savings made by reducing the number of people self-monitoring could be dangerous for the individual and lead to higher
costs for the NHS in the long term," warned care adviser Libby Dowling.
A spokesman for the Department of
Health said: "Self-monitoring cannot be looked at in isolation."